Tao Xipeng, Liang Lan, Xu Junjie, Xie Lici, Wen Qing, Zhou Xiangdong, Luo Hu
Department of Respiratory and Critical Care Medicine, First Affiliated Hospital of Army Medical University, Chongqing, China.
J Thorac Dis. 2025 Jan 24;17(1):278-288. doi: 10.21037/jtd-24-1403. Epub 2025 Jan 22.
Non-small cell lung cancer (NSCLC) presents the most common type of lung cancer, accounting for 80-85% of cases. Combining immunotherapy with radiotherapy (RT) has emerged as a significant research area in recent years. However, the risk of radiation pneumonitis, especially in lung cancer patients, poses a significant concern. Iodine-125 (I) seed implantation offers a precise, less invasive alternative, minimizing damage to surrounding lung tissues and reducing side effects. This study aims to evaluate the safety and efficacy of I seed implantation combined with immune checkpoint inhibitors (ICIs) and chemotherapy (CT) in treating driver gene-negative NSCLC patients.
Retrospective analysis of 95 patients with driver gene-negative NSCLC who presented to the First Affiliated Hospital of Army Medical University was conducted. Among them, 33 cases in the observation group were treated with I seed implantation combined with CT and ICIs (ICIs + CT + I), and 62 cases in the control group were treated with extracorporeal RT combined with CT and ICIs (ICIs + CT + RT). The primary observational endpoint was median progression-free survival (mPFS), while the secondary observational endpoints included the 1- and 2-year PFS rate and the incidence of adverse events.
mPFS was not reached in the observation group but 11.8 months [95% confidence interval (CI): 9.743-13.857] in the control group, a statistically significant difference (P<0.001). The restricted mean survival time (RMST) was 22.2 (95% CI: 18.257-26.101) and 13.8 (95% CI: 11.912-15.718) months in both groups at 31.7 months, PFS was better in the observation group than in the control group. In the observation group, two cases (6.1%) developed grade 3 pneumothorax or hemorrhage, and in the control group, 16 cases (25.8%) developed grade 3 radiation pneumonitis, which was higher in the control group than in the observation group (P=0.02).
Compared to RT in combination with CT and immunotherapy, patients with driver gene-negative NSCLC who received I seed implantation had greater advantages with longer survival and fewer adverse effects.
非小细胞肺癌（NSCLC）是最常见的肺癌类型，占病例的80 - 85%。近年来，免疫疗法与放射治疗（RT）相结合已成为一个重要的研究领域。然而，放射性肺炎的风险，尤其是在肺癌患者中，是一个重大问题。碘 - 125（I）粒子植入提供了一种精确、侵入性较小的替代方法，可将对周围肺组织的损伤降至最低并减少副作用。本研究旨在评估I粒子植入联合免疫检查点抑制剂（ICIs）和化疗（CT）治疗驱动基因阴性NSCLC患者的安全性和疗效。
对陆军军医大学第一附属医院收治的95例驱动基因阴性NSCLC患者进行回顾性分析。其中，观察组33例采用I粒子植入联合CT和ICIs治疗（ICIs + CT + I），对照组62例采用体外RT联合CT和ICIs治疗（ICIs + CT + RT）。主要观察终点是中位无进展生存期（mPFS），次要观察终点包括1年和2年PFS率以及不良事件发生率。
观察组未达到mPFS，而对照组为11.8个月[95%置信区间（CI）：9.743 - 13.857]，差异有统计学意义（P<0.001）。两组在31.7个月时的受限平均生存时间（RMST）分别为22.2（95%CI：18.257 - 26.101）和13.8（95%CI：11.912 - 15.718）个月，观察组的PFS优于对照组。观察组有2例（6.1%）发生3级气胸或出血，对照组有16例（25.8%）发生3级放射性肺炎，对照组高于观察组（P = 0.02）。
与RT联合CT和免疫治疗相比，接受I粒子植入的驱动基因阴性NSCLC患者具有更大优势，生存期更长且不良反应更少。
